Abstract
BACKGROUND: Postoperative depression and anxiety among patients with intestinal tumor surgery are closely related to inflammation and nutritional imbalance, which in turn, can affect quality of life. AIM: To systematically evaluate the occurrence regularity of depression and anxiety, predictive factors, and dynamic effects on the quality of life of patients after intestinal tumor surgery, to provide a basis for clinical psychological intervention. METHODS: This prospective observational study included 120 patients who underwent intestinal tumor surgery. The Hamilton Depression Scale (HAMD-17) and Self-Rating Anxiety Scale (SAS) were applied on the 3(rd), 7(th), and 30(th) days after surgery to assess the psychological state, and the 36-Item Short-Form (SF-36) scale was used to assess the quality of life. The inflammation index [neutrophil-to-lymphocyte ratio (NLR) and albumin-to-fibrinogen ratio (AFR)] and nutrition index were measured simultaneously. Statistical analysis was performed using a mixed-effects model, intermediary analysis, and XGBoost algorithm. RESULTS: In this study sample, the depression and anxiety scores decreased significantly with time (decreases from the 3(rd) to the 30(th) day were all P < 0.05), suggesting that the symptoms gradually improved. The NLR was significantly increased, and the AFR was significantly decreased after surgery (P < 0.05). The partial recovery of albumin and total lymphocyte count at 72 hours post-surgery continuously improved over time (on the 30(th) day compared with that on the 3(rd) day P < 0.05). The scores of each dimension of the SF-36 also increased significantly over time (both P < 0.05, on the 90(th) day compared with that on the 3(rd) day), while the physiological and social functions improved most significantly. In contrast, the overall complication rate decreased significantly over time (P < 0.05), with incisional infection and hemorrhage showing the most significant reduction. The analysis of the mixed effect model showed that time had significant negative/positive effects on the psychological state of patients (HAMD: β = -1.2, P < 0.05; SAS: β = -1.1, P < 0.05), inflammation (NLR: β = -0.85, P < 0.05) and quality of life (SF-36: β = 3.5, P < 0.05). The NLR and AFR played significant intermediary roles in the impact of psychological disorders on quality of life (indirect effect, P < 0.05). The XGBoost model identified hypotension during surgery, postoperative high NLR (> 7.0), and low AFR (< 12.0) as key predictors, with an area under the curve (AUC) of 0.873. The external validation AUC of the XGBoost model was 0.826 (95%CI: 0.775-0.877), with a critical value of 0.612, sensitivity of 78.3%, and specificity of 75.6%. These core predictive factors were consistent with those identified in the original study. CONCLUSION: Psychological disorders after surgery for intestinal tumors are closely related to inflammation activation and nutritional imbalance, and are most significant in the early postoperative period. Intraoperative hypotension and postoperative NLR/AFR abnormalities are strong predictors of psychological risks. Inflammatory markers also play a key intermediary role in the impact of postoperative psychological disorders on quality of life. We recommend measuring NLR and AFR at 24 hours postoperatively, with intervention thresholds set at NLR > 7.0 and AFR < 12.0. Intraoperative blood pressure should be maintained above 90 mmHg to reduce psychological risks. Importantly, a physical and mental integration rehabilitation model should be implemented.